Last Blog of Critical Care Nursing 420

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WOW! I can hardly believe that the semester is over, let alone our nursing program coming to a close! I have to say, this semester is truly where everything “clicked”. I always thought I was strong in clinical, but this was the semester that content such as lab values and ventilator settings actually made sense! I felt like I was able to have conversations with the nurses and doctors during rounds about why certain treatments were being given, rather than just listening to their discussion.

 

For all of nursing school, the entire three years of the program, and even before I started nursing school, I always thought that ER was going to be where I wanted to be. In my leadership rotation, I got to see a different side of the MICU and SICU, and critical care nursing fascinated me. I have completely enjoyed every aspect of critical care nursing being able to experience it now in clinical.

 

I feel like all of the previous work that we put in during this program showed during this rotation. Pulling information from pathophysiology, pharmacology, therapeutic comm, and med surg made all the difference. Having that strong background made this semester feel like everything clicked. By the end of the semester, I cant even compare to where we were on our first day of nursing school. I have grown so much and I know it is for the better. I have learned how important it is to stress patient advocacy because when your patient knows you are looking out for them, they make your job easier and more fulfilling. Critical care as a last semester of nursing school couldn’t have been a better experience, or at a better time. WE DID IT!IMG_9107

One Final Blog

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It is officially one more week until out pinning ceremony. It all seems quite surreal. However, looking back at this course and all we have learned this semester in addition to all of our previous semesters, I feel that I am ready. This course has helped me to bring everything together. In patho we learned patho. In pharm  we learned medications. However, in critical care I feel that I learned how all of these previous courses work as one to help us become competent nurses. Through this course I learned how to look at everything on a whole (labs, ABGs, test results, assessments) to see how it makes these patients with their specific diagnoses. I am excited to put the knowledge I have learned in this course and all of our others to work in the filed of nursing.

Disasters in 2015

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Coincidentally, waiting until today to do this on health care disaster blog has given me an opportunity to look into a disaster that didn’t happen 10 years ago, 5 years ago, or last year—but three days ago. On Saturday April 25th, Nepal experienced a 7.8 earthquake affecting 8 million people that according to CNN news has more than 4,600 people dead, more than 9,000 injured, more than 1 million children urgently in need, and the count continues. As quake relief efforts continue today, officials warn that there are problems of getting aid into the country and then delivering it to some of the remote communities in desperate need.

 

Currently, there are worries about food and water supplies only lasting until the end of the week and so far the weather has showed no mercy to the country as thunderstorms and more bad weather threaten the region.

 

Also, according to a 2011 World Health Organization report, this country of 28 million has only 2.1 physicians and 50 hospital beds for every 10,000 people, making this disaster even worse from the healthcare prospective. In the hospitals, there are reports of doctors are washing up using sterile water and iodine poured from a bottle rather than hot water from a scrub sink, and instead of electric drills, relying on saws of the variety usually only used in war zones and natural disasters due to the lack of electricity. One doctor reported “I’ve seen a lot of situations around the world, and this is as bad as I’ve ever seen it.” The hospitals need more resources and personnel, and even though the help is more than willing to be given, it is not being received.

 

Countries around the world have launched massive aid operations to help victims of the Nepal earthquake, but the distribution of the resources and help is a challenge that Nepal is facing because of the size of this disaster. The question is, are we better prepared than before for this disaster? Well, the main problem seems to be how to effectively coordinate and organize the massive influx of humanitarian aid.

 

You may ask, how are there worries about food and water supplies and help with the hospitals with the enormous amounts of international aid that has been donated? Well, there have been three major obstacles identified that are slowing the efforts of distribution.

 

  1. Airport bottleneck
    1. Relief organizations say the tarmac at Tribhuvan International Airport remains jam-packed with a large number of cargo planes.
    2. Several aircraft carrying essential supplies have been turned away, or diverted to India and elsewhere.
  2. Damaged roads and infrastructure
    1. Remote areas are largely inaccessible
    2. The Nepalese government has not been able to provide relief to all affected areas because of difficulties transporting goods
    3. The helicopters to distribute goods are small and don’t fly in windy and cloudy conditions.
    4. The situation has deteriorated to the point where relief workers are as good as stranded.
  3. Ongoing damage assessment
    1. Authorities leading the response are still trying to fully understand which areas have been affected, how they are affected and what the priorities are.

 

In the past, what has been seen is that it takes a few days for supply and distribution lines to stabilize. They expect that it will be a few more days before the distribution becomes organized because the government is still constrained by the scale of the disaster. Now that the world has become more equip to help at a moments notice, hopefully in the future we can find ways to get around the obstacles that we are seeing now in this situation.

 

 

All information about this disaster has been taken from the following articles:

 

Ng, N. (2015). Nepal struggles to cope with international aid. http://www.cnn.com/2015/04/28/asia/nepal-earthquake-aid-struggle/index.html

 

Hume, T. (2015). Nepal earthquake’s victims overwhelm hospitals. http://www.cnn.com/2015/04/27/world/nepal-earthquake-bir-hospital/index.html

 

Watson, I., Mullen, J., & Smith-Spark, L. (2015). Nepal earthquake: death toll passes 4,700 as rescuers face challenges. http://www.cnn.com/2015/04/28/asia/nepal-earthquake/index.html

Nepal Earthquake

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A 7.8 earthquake recently devastated the country of Nepal. On Saturday, April 25th, a 7.8 earthquake struck 48 miles northwest of the capital of Katmandu. Numerous aftershocks rocked the country with the highest aftershock registering a 6.8. the earthquake was also felt in India and Tibet.Over 1800 people are known to be dead, with just under 5,000 injured and the figures are expected to rise dramatically as search efforts continue.  This earthquake triggered an avalanche on Mt Everest killing at least 17 people there and many others are thought to be stranded. The capital was one of the worst hit areas as many of the building were built with unreinforced brick or crushed stone and many people were hit with flying debris. Many of the country’s medical facilities were rendered inoperable by the large earthquake. Additionally, the capital’s water system is thought to be contaminated. These are two major barriers to providing health care to the survivors. Additionally, due to the large death toll the number of healthcare workers can be assumed to be substantially decreased. The U.S. embassy has already given 1 million dollars to aid in disaster relief along with sending a response team. Australia and the Asian Investment Bank has also given millions in aid. The government of Nepal is asking for medical supplies as well as aid workers to help in the after math. The economy of this country is very much dependent upon tourism. This can be expected to have a large negative impact on their economy. Imagining being a healthcare provider during a natural disaster such as this is hard to imagine but should be a reality for all of us that live here in California. Overcoming obstacles such as lack of supplies, clean water, electricity, and mass injuries and fatalities are common problems after earthquakes. While California has endeavored to become prepared for earthquakes there are still many areas that are unprepared. Additionally, I believe there is only so much preparation a country can do while mother nature can wreak havoc no matter those preparations.

 

Williams, C. J., Makinen, J. & Rai, B. (2015, April, 25). Nepal quake kills over 1,800. Los Angeles Times pp. A1 & A6.

Protected: End of Life Care

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Pull the Plug

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Having discussions about end of life and the type of care that we want is extremely important. When I was in 8th grade my grandma suddenly suffered a brain aneurysm. She survived her trip to the hospital but was intubated and on mechanical breathing with a poor prognosis. It was her wishes if it looked like she would to not remain like this if there was only minimal or no chances of her ever getting off life assisting devices. All of my family was there when stopped everything and she passed. While still devastated, at this age I could understand that this was what my grandma had wanted.

At the same time my mother talked to my sister and me and said she wanted the same thing. My mom said she never wanted to be hooked up to machines, to stay that way and never get off. And she has been open about her wishes ever since this time. She has since made me her medical power of attorney. I think this has helped me to be open about my desires as well. I have shared these desires, which are the same as my mom’s and my grandma’s, with my fiancée. And I had to ask him if he could pull the plug. He certainly did not like the topic and did not want to talk about it at first. However, I told him you never know what’s going to happen in life and it is best to always be prepared then to make someone suffer something they do not want. I told him what happened to my grandma and how she was the epitome of health, always busy always running around. And then so suddenly on life support. He finally said that he would pull the plugs if he had to. When prompted for his wishes in the same situation, he wanted the same as me. I think it is very important to discuss and be open with your family and loved ones about the end of life.

Wait.. WHAT Medications AM I Taking?!

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It seems that all doctors try and fix people with medication before alternative measures. So how much do people know about the medication they are taking? I surveyed my mom and one of my non-nursing friends about what they know about the medications they take and about how much they know about over the counter medications that they take.

 

medications
To start this blog, part of the reason I wanted to ask my mom what she knew, was years ago she was taking 50 mg of Pamelor (normally for depression but in lower doses can be used for other things) for her frequent migraines, which she stated worked very well for her. After nine years on the medication for her migraines she ended up also taking blood pressure medication and beta-blocker for high blood pressure and rapid heart rate. After being sick of taking so many pills at the young age of 40, she sat down and did some research about the medication she was on and found that the side effects of Pamelor included high blood pressure and high heart rate! She stopped taking the Pamelor and shortly after, her blood pressure was lower and so was her pulse and so she was able to stop taking ALL of her medication.

blood-pressure-prescription-medication

Now a few years later in life, my mom is back on blood pressure medication but she controls her blood pressure staying around the pre-hypertensive range after adapting to the DASH diet and becoming more active. Now, to follow up on what she knows off the top of her head- my mom knows that she takes “something that has potassium and a water pill”. She knows that the potassium pill is to go with her water pill. But when I asked her about side effects, she said that she realizes she should sit down and learn more since she should have learned from her previous experience. She does keep her medications written down on the back of her ID card so that she always has them and the doses she takes for when she gives blood and any other time they may be needed.

otc-pain-meds

When asking about over the counter drugs, she knows that aspirin, ibuprofen, and acetaminophen are all different and she knows ibuprofen is an anti-inflammatory. Now to switch over from someone who has taken many medications to someone who has not– hence why I asked one of my non-nursing friends (who does not take any prescribed medications) about what he knows about over the counter medications. When asking him the same question- if he knows the difference between aspirin, ibuprofen, and acetaminophen, he thought that they were all the same but he knew they were for pain. I then asked him if he had a cold regardless of the symptoms what medication he would buy, and he said that he would just take NyQuil or DayQuil and wouldn’t look at the back of the box to see if it takes care of the symptoms he was having. After asking these questions, I did explain that aspirin, ibuprofen, and acetaminophen work against pain differently in the body and therefore should be used in different situations, and that for his current cold when he told me he was feeling congested I told him NyQuil probably won’t help him much.

People go to the medications they know or what they are told to take, and don’t ask questions. They don’t think that taking something as simple as Tylenol for a headache after a heavy night of drinking for a hangover could be a bad thing since it should not be mixed with alcohol, because they aren’t reading the labels. My mom learned through experience, but my friend has not yet. Over the counter medications do have their own side effects and warnings, and just because it is posted on the bottle or box, does not mean people are reading them.

Medications

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This week I talked to my mom and my fiance, Eddie,  about their medications.

Eddie takes levothyroxine regularly. He knows it is also called synthroid.  He knows this drug is for his thyroid and he is supposed to take it every morning, 1 hour before he eats. He does not know any side effects per say, but knows if he does not take it, he feels tired. OTC he takes Advil. He only knows this name and does not know the generic. When asked how often he can take it he responded, “however often the bottle says.”

My mom takes an inhaler for her asthma regularly. She could not remember the name as she has recently started taking it. She does not know any side effects.  She knows she is to use as needed for her symptoms. When asked how she uses the inhalers she stated she puts her mouth on and inhales as she depresses. OTC she takes multivitamins and calcium supplements. She takes Advil for pain as needed. She knows it is also called ibuprofen. Also did not know frequency she could take but knows to read the bottle.

BNP for Heart Failure Treatment? Yes!

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     While reviewing for the exam doing case studies, the book I was reviewing pointed out a new therapy about BNP not only being used as a marker for heart failure, but also as therapy.

While BNP is elevated in acute exacerbations of heart failure, it is also available for IV administration and is marketed as nesiritide (Melander, 2004). Nesiritide is a recombinant human brain natriuretic peptide, BNP 1-32, and is a vasodilator that has undergone clinical trials in patients with acute heart failure (Colucci, 2015). The high level of vasoconstrictors and high systemic vascular resistance and possibly low levels of bioactive BNP in patients with heart failure provides the rationale for therapy with vasodilators, such as nesiritide (Colucci, 2015). Nesiritide has been proven to reduce preload and afterload, and increase cardiac output in people who are experiencing an acute exacerbation of heart failure (Melander, 2004). Also, when compared to it has been proven to improve hemodynamics more quickly than nitroglycerin (Melander, 2004).

            I think further studies should be done on this drug and there should be greater awareness in hospitals about this treatment. The window for treating patients when they are in an acute exacerbation of heart failure should be narrowed so that the damage that is done can be minimized. Since BNP is already produced by the heart as a peptide secreted by the ventricle in response to fluid overload, investigating further in the advantages of using a naturally occurring peptide for treatment should be looked into!

 

References

Colucci, W.S. (2015). Nesiritide in the treatment of acute decompensated heart failure. UptoDate. Retrieved from http://www.uptodate.com/contents/nesiritide-in-the-treatment-of-acute-decompensated-heart-failure

 

Melander, S.D. (2004). Case studies in critical care nursing. Philadelphia, Pennsylvania: Elsevier.

Nutritional Screening Tool for Cardiac Patients

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This week I read an interesting article discussing the utilization of nutritional screening tools for cardiac patients. As we know, diet can play a major role in the development and progression of all types of heart disease and assessing patient’s diet is becoming extremely common and important. This interesting article examined whether a simple five question screening tool could be as effective as the proven diet assessments done by dieticians that are in depth and often take 30 minutes. The quick screening tool asked questions regarding the intake of monounsaturated fats (such as canola oil, olive oil, avocados), whether the client eats seven fruits and vegetables daily, do they eat fish twice weekly, do they have two portions of soluble fiber weekly, and do they drink two or less alcoholic drinks per day. As a side note this research was done in Australia. In Australia only 5.5% eat the recommended daily fruits and vegetables and 20% consume more than the recommended portion of alcohol. I thought these were pretty scary stats.

The study encompassed 34 participants that did both the screening tool by a nurse and the diet assessment by a dietician. What the study found was that the quick screening tool was accurate in determining the amounts of fruits, the amount of alcohol, and amount of fish consumed. However, items such as monounsaturated fats and soluble fiber were not as accurate. This lack of accuracy may be that they are not simple items but need more explanation or thought about these items in their diet. Also the screening tool was not accurate for vegetables. When fruit and vegetables were put together in the question people would meet this goal but when asked separately and in detail by a dietician they found they were eating more fruits than vegetables, giving that question a false positive for vegetables in the screening tool. I think that these types of screening tools may be useful in the hospital setting as they would be quick to administer and may give and overall sense of a patient’s diet. However, I feel that most cardiac patients would benefit with the consultation of a dietician as eating in today’s world and reading food labels can be very difficult.

 

References

 

Neubeck, L., Lowres, N., Jackson, A., Freedman, B., Briffa, T., Bauman, A., & Julie, R. (2014). A simple screening tool for assessment of nutritional status in cardiac patients. British Journal Of Cardiac Nursing, 9(10), 508-512.